| PART I RELIABILITY AND VALIDITY OF GAD-7 AND PHQ-9 AS WELL AS THEIR BRIEF INVENTORY GAD-2 AND PHQ-2 FOR SCREENING ANXIETY AND DEPRESSION IN CARDIOVASCULAR OUTPATIENTS.Objective:The current study aimed to validate the 2-and 7-Generalized Anxiety Disorder (GAD-2 and GAD-7),2-and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in cardiovascular outpatients for screening status of anxiety and depression.Methods:A total of 201 outpatients from psycho-cardiological outpatients departments were consecutively chosen and enrolled into this study. All of them were asked to complete GAD-7, PHQ-9 and the mental psychological assessment by qualified researchers trained by psychiatry according to the Composite International Diagnostic Interviews (CIDI).50 cases were retested to assess the retest reliability after one week. The GAD-2, GAD-7, PHQ-2 and PHQ-9 were validated with the CIDI as the reference criterion.Results:According to the CIDI,74(36.8%) and 42(21.3%) of the 201 outpatients were diagnosed as anxiety and depression. The Cronbach's alpha of GAD-2 and GAD-7 were 0.842 and 0.867, and test-retest reliability of them was 0.823 and 0.861. Compared with CIDI, the cutoff value of the GAD-2 was 2 with a sensitivity of 97.3%, specificity of 59.1%, PPV of 59.3% and NPV of 97.4%; and the area under the curve (AUC) was 0.836 (SE=0.026,95%CI:0.782-0.898). For GAD-7, at the cutoff value of 10 with a sensitivity of 86.4%, specificity of 85.8%,PPV of 88.8% and NPV of 91.5%; and the area under the curve (AUC) was 0.927 (SE =0.032,95%CI:0.813-0.938). The Cronbach's alpha coefficients of PHQ-2 and PHQ-9 were 0.809 and 0.785, and test-retest reliability of them was 0.882 and 0.813. Compared with CIDI, the cutoff value of the PHQ-2 was 3 with a sensitivity of 85.7%, specificity of 69.2%,PPV of 57.1%a nd NPV of 93.6%; and the AUC was 0.806 (SE=0.042,95%CI:0.774-0.889). For PHQ-9 scale, a cutoff value of 10 presented good values of sensitivity of 87.1%, specificity of 83.5%, PPV of 58.7% and NPV of 95.6%; and the area under the ROC curve (AUC) was 0.876 (standard error (SE)=0.032, 95% confidence interval(CI):0.813-0.938).Conclusion:The GAD-2, GAD-7, PHQ-2 and PHQ-9 were reliable and efficient instrument for screening and especially excluding the status of anxiety and depression in cardiovascular outpatients.PART ? COMPARE THE VALUE BETWEEN GAD-7 AND PHQ-9 AND HADS FOR SCREENING ANXIETY AND DEPRESSION IN ACS PATIENTSObjective:This study aims to compare the value of General Anxiety Disorder-7, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale for screening anxiety and depression among acute coronary syndrome patients, and determine the optimum cutoff point.Methods:A population-based survey was conducted in three heart centers of Beijing from June in 2013 to June in 2014. A total of 300 consecutive acute coronary syndrome (ACS) patients were included and enrolled into in this study. All of them were asked to complete GAD-7, PHQ-9 and HADS scales. All the self-rating questionnaires were validated according to the Mini International Neuropsychiatric Interview, Version 5 (MINI). Received operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, predictive value, and likelihood ratios (LR) calculated.Results:(1) According to the MINI,76(25.3%) patients were diagnosed with mild anxiety,64(21.3%) with moderate to severe anxiety disorder; 57(19.0%) and 46(16.3%) were diagnosed mild and moderate to major depression disorder.(2) The Cronbach's alpha coefficients of GAD-7, PHQ-9, HADS-A, and HADS-D were 0.862,0.871,0.827 and 0.831 respectively. (3)The self-rating questionnaires GAD-7, PHQ-9 and HADS had the similar value of screening anxiety and depression mood or mild anxiety and depression. (4) The AUC of GAD-7 and HADS-A, as compared to MINI diagnoses of anxiety, were 0.842 (SE=0.022,95% confidence interval (CI):0.836-0.865) and 0.807 (SE=0.027,95%CI:0.786-0.821). Compared with the MINI diagnoses, the optimum cutoff value of GAD-7 was 10 with a sensitivity of 83.0%, specificity of 86.5%, positive predictive value (PPV) of 59.6% and negative predictive value (NPV) of 94.7%; at the optimum cutoff value of nine (9), the HADS-A had a sensitivity of 80.4%, specificity of 85.5%, PPV of 57.4% and NPV of 94.7%. (5)The AUC of PHQ-9 and HADS-D, as compared to MINI diagnoses of depression, were 0.842and 0.813 (SE =0.027,95%CI:0.806-0.894; SE=0.041,95% CI:0.767-0.852), respectively.Conclusions:The GAD-7, PHQ-9, and HADS were found to be reliable measurement tools for excluding anxiety and depression and in ACS patients, and GAD-7 and PHQ-9 may be superior to HADS for screening moderate to major anxiety and depression disorder.PART III THE PREVALENCE AND RELATED FACTORS OF ANXIETY AND DEPRESSION AMONG ACS PATIENTS.Objective:The study was conducted to explore the incidence and its related factors of clinic anxiety and depression in patients with acute coronary syndrome (ACS).Methods:A population-based survey was conducted in three heart centers of Beijing from June in 2013 to June in 2014. A total of 782 consecutive ACS patients were included in this study. The questionnaire related personal details were completed by patient and clinical material was assessed by investigator within one week after hospitalization. Associated factors of anxiety and depression disorder in ACS patients were analyzed by Multivariate logistic regression.Results:The incidence of anxiety and depression among all the ACS patients were 19.61% and 15.62% respectively. There were 26.95% ST segment elevation myocardial infarction (STEMI) were detected as anxiety and 24.91% as depression, and 25.38% and 19.21% non-ST segment-elevation myocardial infarction (NSTEMI) patients were identified as anxiety and depression respectively, with regards to unstable angina pectoris (UAP) patients, the incidence of anxiety and depression were 14.13% and 8.18%. According to the multivariate logistic regression analysis, it showed the Acute myocardial infarction(AMI), poor sleep quality, lower education level, lower quality of life (the lower score of SF-12 and SAQ) were the independent factors associated with anxiety in the patients with ACS (P<0.05), and AMI, age, poor sleep quality, lower education level, lack of social support(lower score of ESS I) and lower quality of life were the impact factors associated with depression in the patients with ACS (P<0.05).Conclusion:The incidence of anxiety and depression is high in patients with ACS, especially the acute myocardial infarction patients. All the related factors may be modified except increasing age, therefore, part of anxiety and depression of ACS patients may be prevented with associated factors modification. |
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